Free fibula flap thumb salvage after a gunshot wound: Case report emphasizing the orthoplastic approach

Abstract

High-energy hand trauma damaging bone and soft tissue often leads to amputation. Thumb loss leads to significant disability and decreased quality of life. A variety of options exist to preserve or restore thumb function, but many are not viable when significant bone and overlying soft tissue are lost. In this case report, we present a case of a 30-year-old warehouse worker who suffered a gunshot blast injury to the hand, destroying his metacarpophalangeal joint and overlying soft tissue. Initially this was repaired at an outside hospital with a nonvascularized bone graft and no definitive soft tissue coverage that subsequently became infected. Free fibula osteocutaneous flap reconstruction prevented amputation and restored form and function to the thumb. Implementing an orthoplastic approach resulted in thumb salvage and restoration of this patient's quality of life.